scholarly journals Temporal Trends of Infective Endocarditis in Olmsted County, Minnesota between 1970-2018: A Population-Based Analysis

2021 ◽  
Author(s):  
Daniel C DeSimone ◽  
Brian D Lahr ◽  
Nandan S Anavekar ◽  
Muhammad R Sohail ◽  
Imad M Tleyjeh ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Temporal Trends ◽  
Population Based ◽  
Olmsted County ◽  
Calendar Time ◽  
Coagulase Negative Staphylococci ◽  
Significant Difference ◽  
Before And After ◽  
Prevention Guidelines ◽  
Over Time

Abstract Background A population-based study of infective endocarditis (IE) in Olmsted County, Minnesota provides a unique opportunity to define temporal and seasonal variations in IE incidence over an extended time period. Methods Population-based review of all adults (≥18 years) residing in Olmsted County, Minnesota, with definite or possible IE using the Rochester Epidemiology Project from January 1, 1970 through December 31, 2018. Poisson regression was used to characterize the trends in IE incidence; models were fitted with age, sex, calendar time and season, allowing for non-linearity and non-additivity of their effects. Results Overall, 269 cases of IE were identified over a 49-year study period. Median age of IE cases was 67.2 years and 33.8% were females. The overall age- and sex-adjusted incidence of IE was 7.9 cases per 100,000 person-years (95% confidence interval [CI], 7.0 – 8.9), with corresponding rates of 2.4, 2.4, 0.9 and 0.7 per 100,000 person-years for Staphylococcus aureus, viridans group streptococci (VGS), Enterococcus species, and coagulase-negative staphylococci (CoNS) IE, respectively. Temporal trends varied by age, sex and season but on average IE incidence increased over time (P=0.021). Enterococcal IE increased the most (P=0.018), while S. aureus IE appeared to increase but mostly in the winter months (P=0.018). Between 1996 and 2018, the incidence of VGS IE was relatively stable, with no statistically significant difference in the trends before and after the 2007 AHA IE prevention guidelines. Conclusion Overall, IE incidence, and specifically enterococcal IE, increased over time, while S. aureus IE was seasonally dependent. There was no statistically significant difference in VGS IE incidence in the periods before and after publication of the 2007 AHA IE prevention guidelines.

scholarly journals P346 The changing epidemiology of infective endocarditis in a tertiary center

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Denes ◽  
A Bence ◽  
T Ferenci ◽  
S Borbas ◽  
G Prinz ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infective Endocarditis ◽  
Mortality Rate ◽  
Cox Regression ◽  
Temporal Trends ◽  
Tertiary Hospital ◽  
Incidence And Mortality ◽  
Tertiary Center ◽  
Significant Difference ◽  
Over Time

Abstract Background Despite the adequate antibiotic prophylaxis, the incidence and mortality rate of infective endocarditis (IE) is still high. In the past few decades, several studies have noted an increase in the proportion of IE caused by staphylococcal species. Aims The aim of our retrospective study was to assess the clinical and microbiological characteristics, trends, and the 1, 6 and 12-month cardiovascular (CV) mortality rate of patients administered for IE in our tertiary hospital between January 1, 2006 and December 31, 2016. Results We identified 465 cases (311 men, 154 women) of 448 patients, mean age was 56,1 ± 16,4 years (14-92). Native left-sided IE (NLIE) was assessed in 286 cases (61,5%, mitral in 117, aorta in 116, combined in 53 cases), prosthetic valve IE (PVIE) was in 111 cases (24%, early in 44, late in 67), right-sided IE (RIE) in 12 cases (2,5%), cardiac device related IE (CDRIE) in 50 cases (11%), other in 6 cases (1%). The underlying infection was caused by streptococci in 124 cases (27%), Staphylococcus aureus (SA) in 112 cases (24%, out of them 23 had MRSA), coagulase negative Staphylococcus (CoNS) in 39 cases (8%), enterococci in 75 cases (16%). Blood culture negative cases found in 61 patients (13%), in 38 cases (8%) other, diversified germs and in 16 cases (4%) there were no data on the pathogen agent. The mortality rates of the total population were one-month was 12.8%, six-month was 26.4%, one-year was 29.7%, and five-year was 40%. There was a significant difference in the mortality rate regarding both of the type of IE and in terms of the underlying microorganism (log-rank p = 0.03 and p = 0.04 resp). The worst survival rate was detected among patients with PVIE, and patients with staphylococcal infection, especially with MRSA. Cox regression found that age (HR: 1.4; CI:1.3-1.6; p <0.001), ejection fraction (HR: 1.4; CI:1.2-1.5; p <0.001), hemoglobin and creatinin levels (HR: 0.9; CI:0.8-0.97 p = 0.01; HR: 1.3; CI: 1.1-1.5; p = 0.001 resp.), MRSA compared to streptococcal infection (HR: 2.5; CI:1.4-4.5; p <0.001), stroke as complication (HR: 1.98; CI:1.4-2.8; p <0.001) were independent risk factors of mortality. In terms of temporal trends the rate of combined NLIE decreased over time (14.5% to 5.1%, p = 0.03), while the rate of other types of IE did not changed. Regarding the type of underlying microorganism the rate of SA infection increased (17% to 41%, p = 0.002) and the rate of CoNS decreased (16.1% - 1.3% p < 0.001) over time. The 1-year mortality rate did not change through the years. Conclusions During the observed 11 years 465 cases were administered with IE to our tertiary hospital, out of which two-third were NLIE. One-quarter of the underlying microorganism were streptococci, and the rate of Staphylococcus aureus infection was increased over time, which was associated with a worse prognosis. In addition IE had a high mortality, which unfortunately did not improve through the years.

Abstract P372: Coronary Angiography Use, Results and Revascularization Trends in Olmsted County, Minnesota, 2000 to 2015

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Yariv L Gerber ◽  
Susan Weston ◽  
Jill Killian ◽  
Matteo Fabbri ◽  
Sheila Manemann ◽  
...  
Keyword(s):  
Coronary Angiography ◽  
Regression Models ◽  
Direct Method ◽  
Coronary Revascularization ◽  
Temporal Trends ◽  
Olmsted County ◽  
Left Main ◽  
Logistic Regression Models ◽  
Over Time ◽  
Age And Sex

Background: A decline in all forms of coronary revascularization has been previously reported. Whether the decline has continued after the turn of the century is unknown as well as whether it is influenced by trends in the use and results of coronary angiography. Methods: All diagnostic and therapeutic coronary procedures performed among Olmsted County, MN residents from 2000-2015 were analyzed. Standardized rates (per 100,000 population) were calculated applying the direct method and temporal trends compared using Poisson regression models. Trends in disease severity, defined as 3-vessel and/or left main coronary artery disease (CAD), were assessed using logistic regression models. Results: Between 2000 and 2015, 11,691 coronary angiographies were performed (63% men; 54% ≥ 65 years of age). The age- and sex-standardized rates of angiography decreased over time (p trend < 0.001; Figure). Overall, 30% of the subjects had 3-vessel and/or left main CAD, and this proportion decreased over time (age- and sex-adjusted odds ratios (95% CI) for severe CAD: 0.68 (0.62-0.76) in 2005-2009 and 0.69 (0.63-0.77) in 2010-2015 compared with 2000-2004). Among 5,222 coronary revascularization procedures performed, 78% were PCI and 22% CABG. The age- and sex-standardized rates of any revascularization declined during the study period, reflecting temporal decreases in both PCI and CABG (all p trend < 0.001; Figure). The declines in angiography rates, CAD severity, and revascularization utilization were consistently greater in women than men (all P for interactions < 0.01). Conclusions: Declines in all forms of coronary revascularization, which were greater in women than men, have occurred in Olmsted County, MN, from 2000-2015. The declines occurred in the context of fewer angiograms performed in the population and reduced severity of anatomic CAD.

scholarly journals Temporal Trends in Surgical Resection Rates and Biologic Prescribing in Crohn’s Disease: A Population-based Cohort Study

2020 ◽  
Vol 14 (9) ◽  
pp. 1241-1247
Author(s):  
P W Jenkinson ◽  
N Plevris ◽  
S Siakavellas ◽  
M Lyons ◽  
I D Arnott ◽  
...  
Keyword(s):  
Cohort Study ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Biologic Therapy ◽  
Temporal Trends ◽  
Cumulative Risk ◽  
Population Based ◽  
Cumulative Probability ◽  
Cox Regression Analysis ◽  
Over Time

Abstract Background The use of biologic therapy for Crohn’s disease [CD] continues to evolve, however, the effect of this on the requirement for surgery remains unclear. We assessed changes in biologic prescription and surgery over time in a population-based cohort. Methods We performed a retrospective cohort study of all 1753 patients diagnosed with CD in Lothian, Scotland, between January 1, 2000 and December 31, 2017, reviewing the electronic health record of each patient to identify all CD-related surgery and biologic prescription. Cumulative probability and hazard ratios for surgery and biologic prescription from diagnosis were calculated and compared using the log-rank test and Cox regression analysis stratified by year of diagnosis into cohorts. Results The 5-year cumulative risk of surgery was 20.4% in cohort 1 [2000–2004],18.3% in cohort 2 [2005–2008], 14.7% in cohort 3 [2009–2013], and 13.0% in cohort 4 [2014–2017] p &lt;0.001. The 5-year cumulative risk of biologic prescription was 5.7% in cohort 1, 12.2% in cohort 2, 22.0% in cohort 3, and 44.9% in cohort 4 p &lt;0.001. Conclusions The increased and earlier use of biologic therapy in CD patients corresponded with a decreasing requirement for surgery over time within our cohort. This could mean that adopting a top-down or accelerated step-up treatment strategy may be effective at reducing the requirement for surgery in newly diagnosed CD.

Suicides in Los Angeles County in Relation to the Northridge Earthquake

2004 ◽  
Vol 19 (04) ◽  
pp. 307-310 ◽  
Author(s):  
Kimberley Shoaf ◽  
Cary Sauter ◽  
Linda B. Bourque ◽  
Christian Giangreco ◽  
Billie Weiss
Keyword(s):  
Los Angeles ◽  
Rare Events ◽  
The United States ◽  
Suicide Mortality ◽  
Northridge Earthquake ◽  
Systematic Relationship ◽  
Suicide Rates ◽  
Significant Difference ◽  
Before And After ◽  
Over Time

AbstractIntroduction:Recently, there has been speculation that suicide rates increase after a disaster. Yet, in spite of anecdotal reports, it is difficult to demonstrate a systematic relationship between suicide and disaster. Suicides are fairly rare events, and single disasters rarely have covered geographic areas with large enough populations to be able to find statistically significant differences in such relatively rare events (annual suicide rates in the United States average 12/100,000 population).Hypothesis:Suicide rates increased in the three calendar years (1994–1996) following the Northridge earthquake as compared to the three calendar years (1991–1993) prior to the earthquake. Likewise the suicide rates for 1993 are compared with the rates in 1994. By looking at the suicide rates in a three-year period after the earthquake, the additional disasters that befell Southern California in 1995 and 1996 may have had an additive effect on psychological disorders and suicide rates that can be measured.Methods:Data on suicide mortality were compiled for the years from 1989 through 1996. Differences in rates for 1993 compared with 1994 and for three-year periods before and after the earthquake (1991–1993 vs. 1994 –1996) were analyzed using az-statistic.Results:There is a statistically significant difference in the rates for the years prior to the earthquake (1991–1993) when pooled and compared to the suicide rates for the years after the earthquake (1994–1996). The rates of suicide are lower in the three years following the earthquake (11.85 vs. 13.12/100,000 population) than they are in the three years prior to the earthquake (z= -3.85,p&lt;0.05). Likewise, there is a similar difference when comparing 1993 to 1994 (11.77 vs. 13.84,z= -3.57,p&lt;0.05). The patterns of suicide remain similar over time, with males and non-Hispanic Whites having the highest rates of suicide.Conclusion:It does not appear that suicide rates increase as a result of earthquakes in this setting. This study demonstrates that the psychological impacts of the Northridge earthquake did not culminate in an increase in the rates of suicide.

The identity of the invasive yellow-striped terrestrial planarian found recently in Europe: Caenoplana variegata (Fletcher & Hamilton, 1888) or Caenoplana bicolor (Graff, 1899)?

Zootaxa ◽  
2020 ◽  
Vol 4731 (2) ◽  
pp. 193-222
Author(s):  
HUGH D JONES ◽  
EDUARDO MATEOS ◽  
MARTA RIUTORT ◽  
MARTA ÁLVAREZ-PRESAS
Keyword(s):  
United Kingdom ◽  
Reproductive System ◽  
Sexual Maturity ◽  
Junior Synonym ◽  
The United Kingdom ◽  
Significant Difference ◽  
Before And After ◽  
Yellow Stripe ◽  
Anatomical Information ◽  
Over Time

Terrestrial planarians with a dorsal yellow stripe and dark lateral surfaces and up to 15-20 cm long have been found in several countries in Europe, the earliest in 2008. They are similar to two species originally from Australia, Caenoplana variegata (Fletcher & Hamilton, 1888) and C. bicolor (Graff, 1899), both described on external characters only, with no anatomical information. Careful reading suggests that there is no significant difference between the original descriptions. Further: observations on live specimens show considerable variation between individuals and in individuals over time and before and after feeding, negating any distinction between descriptions. Examination of three sectioned specimens shows considerable difference in sexual maturity, though one seems almost fully mature and the reproductive system is described. Molecular results show that specimens from the United Kingdom and Spain are of the same species. It is concluded that the planarians should be referred to as C. variegata, C. bicolor being a junior synonym. 

scholarly journals 472 Epidemiology and temporal trends of cardiac device related infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Denes ◽  
A Bence ◽  
T Ferenci ◽  
S Borbas ◽  
Z Som ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Temporal Trends ◽  
Mortality Rates ◽  
Coagulase Negative Staphylococcus ◽  
Cardiac Device ◽  
Native Valve ◽  
Tertiary Referral Center ◽  
Device Implantation ◽  
Epidemiological Characteristics ◽  
Over Time

Abstract Background Infective endocarditis (IE) is a rare, but life-threatening complication of cardiac device implantation. Despite recent preventive strategies, and advances in antimicrobial and surgical treatment, morbidity and mortality rates are still high. Aims The objective of our study was to assess the epidemiological characteristics, temporal tends and mortality rate of cardiac device related IE (CDRIE) in our high-volume, tertiary referral center. Methods retrospective data collection was performed from January 1, 2006 to December 31, 2016. Thirty-day, 6-month and 1-year mortality was estimated, which were compared to left-sided native valve endocarditis (LSNIE). Patients administered between 2006 and 2010 and between 2011 and 2016 were compared to assess temporal trends. Results 465 cases of IE were administered, out of whom 54 patients had CDRIE (39 males [72%], mean age: 55.8 ±19 yrs; 4 VVI, 7 VDD, 7 VVI-ICD, 20 DDD, 5 DDD-ICD and 11 CRT devices; median time since first implantation: 1558 days [IQR: 470 days – 8.6 yrs]). The infection was caused by streptococci in 3 cases (5.5%), Staphylococci were the most prevalent infective agents (70%), S. aureus (SA) in 28 cases (52%, out of whom 10 were MRSA), coagulase negative Staphylococcus in 10 cases (18.5%), blood culture negative cases in 8 patients (15%), and in 5 cases other pathogens were responsible. 266 patients had LSNIE (201 males [75%], mean age: 54.4 ± 15.6 yrs). There was no difference between the two groups in age or in portion of males. Mortality rates were the same in CDRIE group compared to LSNIE group (30-day: 13% vs 13%, 6-month: 20% vs 25%, 1-year: 26% vs 29% and long-term: 44% vs 44%, ns resp.) Patients who died in the CDRIE group (n = 25) were older (64 yrs [IQR:59-71 yrs] vs 52 yrs [IQR: 27-69 yrs], p = 0.02), male sex was less common (52% vs 79%, p = 0.03), had lower ejection fraction (39.6 ±16.6% vs 54.6 ±14.5%, p &lt; 0.001), had worse renal function (GFR: 46.3 ± 15.3 vs 60.2 ± 23.5 ml/min/1.73m2, p = 0.04), shorter time since first device implantation (2.1 yrs [IQR: 1.1-4.8 yrs] vs 6.7 yrs [4.1-12.9 yrs], p = 0.006), and CRT device implantation were more prevalent (32% vs 10%, p &lt; 0.05). Patients admitted before 2011 (n = 22) did not differ from patients admitted after 2011 (n = 32) in terms of age, male gender, concomitant valve infection, pocket infection, or embolic event. The 30-day (0% vs 6%) and the 1-year mortality (18% vs 31%) were the same before and after 2011, but the 6-month mortality was better before 2011 (4.5% vs 31%, p = 0.01). CRT device implantation was more prevalent over time (5% vs 31%, p = 0.01), and SA infection became more frequent (36% vs 63%, p = 0.05) Conclusions During the last decade patients with CDRIE had a same survival as patients with LSNIE, every fourth patient died one year after the diagnosis. Almost three-quarter of the infections were caused by Staphylococci, and the portion of S. aureus infection increased over time.

scholarly journals 2312. Mortality of Severe Dengue Patients Admitted to Intensive Care Units over 15 Years: Have We Improved?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S792-S792
Author(s):  
Fernando Rosso ◽  
Luis Gabriel Parra-Lara ◽  
Ana M Sanz ◽  
Gustavo A Ospina-Tascon ◽  
Marcela Granados
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Healthcare Management ◽  
Severe Dengue ◽  
Early Admission ◽  
Early Access ◽  
Monitoring Strategies ◽  
Significant Difference ◽  
Before And After ◽  
Over Time

Abstract Background Dengue mortality can be preventable in endemic regions. However, access to intensive care units (ICU) and continuous monitoring strategies are limited in developing countries. In 2010, WHO dengue clinical practice guidelines (CPG) were implemented in the Americas region which strengthened hospital healthcare management and prioritized early ICU admission in severe dengue cases. We hypothesized that early access to the ICU might decrease the mortality of patients with dengue. This study aimed to describe trends in dengue cases and mortality in the ICU for 15 years in Cali, Colombia. Methods An observational retrospective study about dengue cases treated in adult ICU was conducted, in the Fundación Valle del Lili. We included cases between 2001 to 2015 years. Clinical data were collected from the ICU database and medical charts. A Cochran-Armitage test for trend was used to assess the presence of an association between fatal cases and total cases in dengue patients at ICU during the study period, and to evaluate differences in the mortality cases before and after the implementation of the dengue CPG. Results A total of 49,962 episodes of attention in ICU were analyzed, and 70 cases with severe dengue and dengue shock attended in ICU were included. The median age was 42 years (IQR = 24–60), eight cases were older than 65 years, and 54% were male. Five fatal cases were reported during this period. The fatal cases had a length of stay in ICU of 2 days (IQR = 1–4) vs. 2 days (IQR = 1–3) for nonfatal cases. Overall mortality for dengue cases in the ICU was 7.14%. The highest mortality was presented in 2007 with 33.33% (1/3), and after 2010 there were no fatal cases. Dengue mortality showed a decreasing linear variation over time in the ICU (p = 0.047); also there was a statistically significant difference over time in adults mortality before and after of implementation of dengue CPG (P = 0.029). Conclusion Dengue mortality cases in the ICU have decreased in the last 15 years, which is related to early admission to the ICU and continuous clinical monitoring. Disclosures All authors: No reported disclosures.

scholarly journals Oral Morphine Use in South India: A Population-Based Study

2017 ◽  
Vol 3 (6) ◽  
pp. 720-727 ◽  
Author(s):  
M.R. Rajagopal ◽  
Safiya Karim ◽  
Christopher M. Booth
Keyword(s):  
Temporal Trends ◽  
Oral Morphine ◽  
Population Based ◽  
Private Institutions ◽  
Middle Income ◽  
Middle Income Countries ◽  
Provider Characteristics ◽  
Regional Trends ◽  
Per Capita ◽  
Over Time

Purpose Access to opioids for pain control is recognized as an urgent issue in low- and middle-income countries. Here we report temporal and regional trends in morphine use in Kerala, India. Methods Oral morphine use data for the State of Kerala (2012 to 2015) was used to describe temporal trends, regional variation, and provider characteristics. Total morphine use was calculated for each district of Kerala to derive an annual per capita use rate (milligrams per capita). Each provider was classified as government, private, nongovernment organization (NGO), or NGO partnership. Results Oral morphine use for Kerala was 1.32 mg/capita and increased over the study period 27% (from 1.23 mg/capita to 1.56 mg/capita). There was substantial variation in morphine use across districts (range, 0.49 mg/capita to 2.97 mg/capita; six-fold difference). This variation increased over time (19-fold difference in 2015). In 2015, 31% of morphine providers (51 of 167) were government institutions; they delivered 48% of total morphine in Kerala. Corresponding data for other providers are private institutions, 23% of centers and 13% of morphine; NGOs, 41% of centers and 34% of morphine; and NGO partnerships, 5% of centers and 4% of morphine. From 2012 to 2015, the total number of centers increased by 35%, from 124 to 167. Conclusion Oral morphine use has increased over time in Kerala but remains substantially lower than estimated need. There is significant geographic variation of use. Efforts are needed to improve palliative care in Kerala and to reduce regional disparities in access to opioids.

scholarly journals Increased Incidence and Impact of Upper and Lower Gastrointestinal Events in Patients with Rheumatoid Arthritis in Olmsted County, Minnesota: A Longitudinal Population-based Study

2012 ◽  
Vol 39 (7) ◽  
pp. 1355-1362 ◽  
Author(s):  
ELENA MYASOEDOVA ◽  
ERIC L. MATTESON ◽  
NICHOLAS J. TALLEY ◽  
CYNTHIA S. CROWSON
Keyword(s):  
Rheumatoid Arthritis ◽  
Rate Ratio ◽  
Population Based ◽  
Incidence Rates ◽  
Olmsted County ◽  
Calendar Time ◽  
Upper Gi ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
Incidence And Mortality

Objective.To assess the incidence and mortality impact of upper and lower gastrointestinal (GI) events in rheumatoid arthritis (RA) compared to non-RA subjects.Methods.We identified incident upper and lower GI events and estimated their incidence rates using person-year methods in a population-based incident RA cohort of residents of Olmsted County, Minnesota, USA (1987 American College of Rheumatology criteria first fulfilled between January 1, 1980, and January 1, 2008) and non-RA subjects from the same population.Results.The study included 813 patients with RA and 813 non-RA subjects (mean followup 10.3 and 10.8 yrs, respectively); 68% women; mean age 55.9 yrs in both cohorts. The rate of upper GI events/100 person-years was 2.9 in RA versus 1.7 in the non-RA cohort (rate ratio 1.7, 95% CI 1.4, 2.2); for lower GI events, the rates were 2.1 in RA versus 1.4 in the non-RA cohort (rate ratio 1.5, 95% CI 1.1, 1.9). The incidence of upper GI bleed, perforation, ulcer, obstruction, and any upper GI event in RA declined over calendar time; the incidence of lower GI events remained unchanged. Exposure to glucocorticoids, prior upper GI disease, abdominal surgery, and smoking were associated with lower GI events in RA. Both upper and lower GI events were associated with increased mortality risk in RA.Conclusion.There is increased risk of serious upper and lower GI events in RA compared to non-RA subjects, and increased GI-related mortality in RA. Prominent declines in incidence of upper, but not lower GI events in RA highlight the need for studies investigating lower GI disease in patients with RA.

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